Provider Demographics
NPI:1609512490
Name:JACKSON, BRITTANY (CNA, GNA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CNA, GNA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA, GNA
Mailing Address - Street 1:600 WINGLEAF CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2522
Mailing Address - Country:US
Mailing Address - Phone:443-855-4580
Mailing Address - Fax:
Practice Address - Street 1:600 WINGLEAF CT
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2522
Practice Address - Country:US
Practice Address - Phone:443-855-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00130425376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide